NPIMap

Organization Active NPI

Phoenix Clinic Inc of Broward

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Miramar, FL
National Provider Identifier
1811927262
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1006AD354501 Issued in FL
Legal business name
PHOENIX CLINIC INC OF BROWARD
Practice address
2212 SW 60TH Terrace
Miramar, FL 33023
Phone
(954) 491-2133
Fax
(954) 491-2344
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bonnie Graham
Title
Chief Executive Officer
Phone
(305) 891-3439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1006AD354501 FL Primary

Addresses

Primary practice location

2212 SW 60TH Terrace
Miramar, FL 33023

Mailing address

2212 SW 60TH Terrace
Miramar, FL 33023
Phone (954) 491-2133

National Provider Directory

National Provider Directory

Locations

2040 NE 49th St
Ft Lauderdale, FL 33308
Phone (954) 493-8875

2212 SW 60th Ter
Miramar, FL 33023
Phone (954) 491-2133

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312761600000",
    "number": "1811927262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2212 SW 60TH TERRACE",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33023",
            "telephone_number": "954-491-2133",
            "fax_number": "954-491-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2212 SW 60TH TERRACE",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "33023",
            "telephone_number": "954-491-2133",
            "fax_number": "954-491-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX CLINIC INC OF BROWARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2011-08-08",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-891-3439"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "1006AD354501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.